MS Relapses are typically focal neurological events, although some may be concurrently multi-focal at onset. Relapses may also be referred to as attacks or exacerbations.

Examples include:

• Optic neuritis – This is inflammation of the optic nerve and can result in vision loss (usually in one eye), ocular pain, or a frontal headache. Optic Neuritis occurs as an initial demyelinating event in 20% of MS patients, and approximately half of MS patients will experience optic neuritis at some point in time. Optic neuritis typically occurs in a single eye. Over 90% of people with optic neuritis relapses will get 20/40 or better vision back in their affected eyes.
• Brainstem attack – Results in numbness or weakness on the face, double vision, vertigo, or other types of symptoms of the head and face.
• Transverse myelitis – Attack of the spinal cord that can lead to numbness or weakness in the waist or chest down (thoracic spine lesions), or in arms/legs Cervical spine lesions). There may also be bowel, bladder and sexual dysfunction. Neuropathic pain can be associated in these areas as well. An ‘MS Hug’ or dysesthesia refers to a tightening sensation usually around the torso or chest and is associated typically with a thoracic spine lesion. While patients may feel like they are not moving adequate air while breathing, actual respiration is typically normal. This is due to the abnormal or diminished sensation in chest wall movement.
• Cerebellar attack – Relapse activity in the cerebellum can present with balance issues, vertigo, tremor, dysarthria, and other related symptoms.
• Cerebral attack – While uncommon, isolated cognitive impairment may be manifested as an acute attack.

Treatments of MS relapses are aimed at slowing or stopping MS disease activity and relieving the symptoms manifesting in a patient as quickly and comfortably as possible. Depending on presentation, there are many interventions available to medical providers, including:

• Steroids: A minority of relapses are very mild and not disabling, and do not necessarily require treatment. Many, however, can be disabling and are typically treated with a high-dose steroid which may be taken intravenously (IV) or orally. Most commonly this is one gram of methylprednisolone daily for 3-5 days. Some providers also use a slow taper over 7-10 days as well, but this can be associated with more steroid side effects, such as acne and infections such as oral or vaginal yeast infections. Rarely, a patient may be allergic to methylprednisolone, and an alternative, equivalent-dose steroid may be employed. Subcutaneous ACTH preparations are also available, at dramatically higher costs and with no data showing better outcomes.
  • Plasmapheresis (PLEX) is used if there is a less than satisfactory response to the steroids, typically five exchanges over 5-7 days.
  • If patient is on a DMT and experiences a relapse, talk to their neurologist about the DMT usage. To talk to an MS specialist neurologist, you can call our DocLine at 720-848-2828, and ask to speak to the neurologist covering the Rocky Mountain Multiple Sclerosis Center at the University of Colorado.

Pseudo-Relapse

Previously damaged areas or existing lesions from a previous MS relapse can suddenly “flare up.” That is, a patient may experience recurrence of old symptoms that had stabilized after a remission. This may occur with a variety of stressors, but especially infections, excessive heat, or emotional or physical trauma. These are typically not associated with new MRI lesions and resolve when the underlying stressor is treated or removed. These recurrent symptoms have several names, including recrudescence or more commonly “pseudo-relapse”, a somewhat unfortunate term, as the symptoms are very real. They are simply not associated with new damage, as in a “true” relapse. Pseudo-relapses may occur in any MS patient but are more likely the cause of recurrent symptoms as people age with MS.

• Treatment of a pseudo-relapse: In most cases, once those underlying causes are treated (eg antibiotics for an infection, cooling down if overheated, or resolving the stressor), a pseudo-relapse will subside and the patient returns to baseline symptoms and function. In some patients, especially those who are older and may have accumulated more disability and are wheelchair- or bed-bound, however, even a pseudo-relapse may result in an apparent more permanent loss of function. This is likely due to marked deconditioning, and physical therapy is essential.